Monday, April 09, 2007

Going Too Far: POST #2 - Complete College Smoking Bans

In the first part of this two-part series, "Going Too Far," I highlighted an example of a proposed citywide outdoor smoking ban that is too excessive to be justified in terms of protecting nonsmokers from a significant health hazard. In this second part, I comment on the growing trend of college campuses that are instituting complete bans on smoking and/or all tobacco use.

According to an article in the Orange County Register, three colleges in California ban smoking completely - both indoors and outdoors. Fullerton College recently enacted a ban on all smoking by students and part-time faculty and staff members; full-time employees of the college are exempt.

According to the same article, at least some anti-smoking groups are encouraging and supporting these complete college smoking bans: "The American Cancer Society publishes a how-to guide for campuses that want to prohibit smoking. Among the recommendations: Find students to spearhead the effort. Phase it in slowly. Combine it with stop-smoking programs."

Another anti-smoking group that appears to be supporting these efforts is the California Youth Advocacy Network, which describes itself as a "statewide coalition promoting tobacco-free colleges and universities in California." This group, supported by the California Department of Health Services, has put out a model college smoke-free policy, which includes as one option a complete ban on all outdoor and indoor smoking on campuses: "As of August 1, 2004, smoking is prohibited on all property and in all indoor and outdoor spaces owned, leased, licensed, or otherwise controlled by [campus name]. Signs stating “NO SMOKING ON CAMPUS and other [campus name] controlled locations.” shall be posted at major campus entry points."

Perhaps the most stringent nonsmoking policy was recently approved by the staff council at the University of New Mexico. This policy would ban all tobacco use on campus -- both smoking and smokeless tobacco use and both indoors and outdoors. It needs approval by the regents before it goes into effect.

According to an article in the New Mexico Daily Lobo: "Donald Burge, who presented the resolution, said it goes beyond the resolution for the Health Sciences Center. The Board of Regents approved a smoking ban for the Health Sciences Center on Feb. 14. 'What the resolution that I put forward (Tuesday) calls for is not just smoke-free but to go tobacco-free,' he said. 'There are deleterious effects of people chewing and spitting. Those effects are just as bad if not worse than secondhand smoke.' Burge said there was no discussion in the crafting of the resolution about including a smoking section on campus to accommodate smokers."

"'Quite frankly, I do not buy into the argument of smokers' rights,' he said. 'If you're going to talk about the rights of smokers, you're going to have to ask at what point the smoker has the right to harm others.' Burge said a smoking section outdoors is unacceptable, because people's lives would still be in danger. 'When you have a public institution, that institution has a duty to protect the safety of the people in or on that institution,' he said. Cigarettes are still a danger to people, even after they have been put out, Burge said. 'Most people will, in fact, simply throw it on the ground. Somebody has to clean that up,' he said. 'Picking up cigarette butts exposes the person who has to pick them up.'"

The Rest of the Story

So let's get this straight. There are deleterious effects of smokeless tobacco on non-smokeless tobacco users that are "just as bad if not worse" than the effects of secondhand smoke on nonsmokers. And since we all know that even 30 minutes of secondhand smoke can cause instant death, I can only imagine all the people that are dropping dead from being in the vicinity of someone with a wad of chewing tobacco in their mouth.

I have to admit that the concept of secondhand smokeless tobacco is a new one to me. I realize that back in my playground days, kids used to put chewing gum in each other's hair as a practical joke, but I didn't realize that anything similar was going on with smokeless tobacco. Or is the idea that the chewing action causes the tobacco constituents to vaporize and then float through the air and expose non-users? I admit that I have to brush up on the part of my epidemiologic education that dealt with secondhand effects of smokeless tobacco use.

I also have to admit that I didn't realize how hazardous cigarette butts are, or that sweeping a butt with a broom or other outdoor cleaning device causes the sweeper to be exposed to noxious fumes. I recognize that cigarette butts may represent a nuisance or a source of litter, but I didn't realize that they represented a substantial immediate human health hazard.

I also have to admit that I didn't realize that people's "lives are in danger" from a remote outdoor smoking area. It always seemed to me that nonsmokers could simply avoid walking near that smoking area. I didn't realize that these outdoor smoking areas are killing people. Had I known that, I might not have lobbied so vigorously for bar and restaurant smoking bans, since I know that those policies have resulted in smokers congregating in outdoor areas, which is apparently putting people's lives in danger.

But my apparent ignorance of these scientific facts pales in comparison to my ignorance about the differential effects of smoking on students compared to faculty members and on full-time as opposed to part-time employees. I honestly had no idea that smoking was a severe health hazard for students, but that it was perfectly acceptable for faculty members. I also had no idea that while smoking is an unacceptable health threat to part-time employees, it is not so much of a problem for full-time employees. I had always thought that tobacco was an equal opportunity killer, but apparently it discriminates on the basis of employment status.

Frankly, the anti-smoking movement is going to make itself look stupid if it continues to pursue these extreme policies and to back them up with such ridiculous arguments. If you're going to support complete smoking bans on college campuses, then at least acknowledge the real reason behind it. Don't hide behind these idiotic explanations.

The inescapable fact is that those who are supporting complete college smoking bans have crossed the line from protecting nonsmokers from secondhand smoke to trying to protect smokers from themselves. In other words, they have crossed the line from health protection to unenlightened paternalism.

That may be acceptable, but at very least, call it what it is. These policies represent the use of coercion to attempt to change a health behavior, not to protect innocent bystanders, but to protect the person engaging in that behavior.

To me, this crosses a line that we ought not cross in public health. While I think we are justified in using educational and persuasive approaches to try to protect people from their own unhealthy behaviors, I do not believe that we are justified in using a coercive approach unless the person's behavior is affecting other people.

If we're willing to cross this line with regards to smoking, then there is really nothing to stop us from crossing the same line with regards to all other health behaviors. If we are willing to ban tobacco use on college campuses to promote health, then there is no reason why we should not also ban alcohol use, ban trans-fat intake, ban excessive fat intake, ban the consumption of tater tots, require a set amount of daily physical activity, and ban the consumption of more than 2 grams of sodium per day among hypertensives on campus. We should also ban college hockey, football, and lacrosse. I'm just saying...if we truly want healthy college campus environments.

If anti-smoking groups want to pursue this type of paternalism on their own, I suppose that is their right, but I do find it problematic that these efforts are apparently being supported by taxpayer funding (through the California Department of Health Services). If the California Department of Health Services wants to support paternalistic intervention, that's fine I guess, but the Department at least needs to be consistent. Let's also see some taxpayer funding of initiatives to dictate people's diet, physical activity, sexual activity, alcohol use, and the other major health behaviors which are responsible for the bulk of preventable disease in California.

It's odd that you don't see public health advocacy groups pushing for alcohol-free college campuses, trans-fat free college campuses, or requirements on physical activity for college students. The only behavior for which we see a paternalistic approach is tobacco use.

I can't help but wonder why that is. Why would smoking be singled out as the one behavior for which we need to coerce its non-use, while for every other health behavior, people are allowed to make their own decisions (although we educate them and try to persuade them to make healthy choices). But not for smoking and tobacco use. It's apparently not enough to educate people or even to use aggressive persuasion to get them to quit smoking. Instead, we have to coerce the non-use of tobacco products.

I'll be honest. My perception is that the reason smoking is being singled out is that there is some underlying hatred of smokers and a disrespect for their life choices, as well as for their right to make these choices. To some extent, I think this is a class issue (keep reading The Rest of the Story later this week for more on the class issues in recent anti-smoking initiatives). We do tend to disrespect choices made by smokers, but to respect equally unhealthy choices made by the upper classes.

In fact, you can see this class issue start to bear out on the Fullerton campus. The students and part-time workers are coerced into not smoking, while the faculty are left to make their own health decisions.

The rest of the story is that complete college smoking bans are an example of the anti-smoking movement going too far because they cross the line into unenlightened paternalism. They aim to control health behavior through the use of coercion, rather than using education and persuasion to try to encourage people to make healthy behavior choices.

While I oppose such an approach and would hope that the anti-smoking movement would not continue in this direction, at very least, we should admit what we are doing and the reasons behind it, rather than hide behind inane excuses such as the life-threatening hazards of outdoor smoking in remote areas, the harmful effects of secondhand smokeless tobacco, or the extreme hazards of cleaning up cigarette butts.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.